complications management

about complications management

Due to Clinic Director, Dr Steven Land’s experience – not only with aesthetic medicine, but working in Emergency Medicine at the RVI, Newcastle – we have received many referrals over the years directly from other practitioners, as well as A&E, who are not equipped to rectify aesthetic treatment issues. 

As the industry in the area boomed over the years, we found that emergency complications and aesthetically unpleasing results were becoming more common, and often patients were finding their way to us to fix their issues. 

Even the best practitioners in the world can cause an emergency issue, however appropriate health and safety protocols, stringent infection control policies, extensive anatomy knowledge, and the ability to rectify these issues when they arise are essential to safe practice.

However, we have found that there has been a substantial rise in emergencies since the introduction of “1 day fast track courses” and since many unscrupulous practitioners have began training others to inject.

Complications fall into two categories;

Minor, ie;

  • Droopy eyelids from botulinum toxin treatment
  • “Spocky” eyebrows
  • Filler becoming lumpy
  • Filler being too superficial – resulting in the “tindle” effect where it appears blue
  • An aesthetically unappealing result
  • Skin issues caused by skin treatments


Emergency, ie;

  • Infection
  • Vascular Occlusion (VO) or additional vascular pressure – where the blood supply has been compromised either due to filler being injected directly into an artery or is putting substantial pressure on the artery
  • Necrosis caused by injecting fat dissolving products too superficially
  • Imitation or unlicensed products being injected and causing reactions

Extreme pain immediately after a filler treatment is the most obvious symptom.
The area may be blanched (white) or mottled. 
Areas of skin begin breaking down or turning black may be late signs of a VO.

If you suspect an occlusion, we recommend watching yourself in a mirror and pressing down on the area for 5 seconds. When you release, try to time how long it takes for the skin to turn from white/paled back to your natural skin tone. If it takes more than 3 second, contact your practitioner immediately!

Dermal fillers can be dissolved with a prescription only enzyme called Hyaluronidase. This breaks down and redistributes the HA molecules.

An appropriately qualified medical prescriber needs to be prescribing hyaluronidase for you as an individual patient. If you have seen a non-medical practitioner and they are offering to dissolve without you seeing their prescriber in person, they are breaking the law.

With our extensive knowledge of anatomy, we can pinpoint the specific issue that’s caused the complication and combat it appropriately.

For example;

  • Droopy eyelid (or ptosis) after a botox treatment – we can target with prescribed eyedrops or with two tiny injection points across the eyelid to improve the appearance of the ptosis
  • VO or badly placed filler – we are proud to be the first clinic in the North to implement facial ultrasound into our practice. By using ultrasound, we can get a clear image of exactly where filler is placed under the skin, and inject the dissolving agent (hyaluronidase) in a much more targeted manner. 

Assuming that the dermal fillers are provided by a reputable pharmacy, as a whole they are safe.

Where complications arise is in the actual injection of the fillers. While complications such as vascular occlusions can occur to the best injectors, the mitigation of this risk is a result of extensive anatomy knowledge. Everyone’s anatomy is slightly different, so if our medical team have any concerns about a potential complication, they can use ultrasound to map out your blood vessels. If a complication does arise, our team is extensively trained in managing occlusions, so you’re in the best hands to rectify any issues, and we are recognised as an unofficial complications centre in the North East by other medical aesthetics injectors in the region.

pricing information

Ultrasound £50
Dermal filler dissolving £250
Out of hours dissolving £350

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